Diane Habash

Daily Stressors, Past Depression, and Metabolic Responses to High-Fat Meals: A Novel Path to Obesity

BACKGROUND Depression and stress promote obesity. This study addressed the impact of daily stressors and a history of major depressive disorder (MDD) on obesity-related metabolic responses to high-fat meals. METHODS This double-blind, randomized, crossover study included serial assessments of resting energy expenditure (REE), fat and carbohydrate oxidation, triglycerides, cortisol, insulin, and glucose before and after two high-fat meals. During two separate 9.5-hour admissions, 58 healthy women (38 breast cancer survivors and 20 demographically similar control subjects), mean age 53.1 years, received either a high saturated fat meal or a high oleic sunflower oil meal. Prior day stressors were assessed by the Daily Inventory of Stressful Events. RESULTS Greater numbers of stressors were associated with lower postmeal REE (p = .008), lower fat oxidation (p = .04), and higher insulin (p = .01), with nonsignificant effects for cortisol and glucose. Women with prior MDD had higher cortisol (p = .008) and higher fat oxidation (p = .004), without significant effects for REE, insulin, and glucose. Women with a depression history who also had more stressors had a higher peak triglyceride response than other participants (p = .01). The only difference between meals was higher postprandial glucose following sunflower oil compared with saturated fat (p = .03). CONCLUSIONS The cumulative 6-hour difference between one prior day stressor and no stressors translates into 435 kJ, a difference that could add almost 11 pounds per year. These findings illustrate how stress and depression alter metabolic responses to high-fat meals in ways that promote obesity.

Marital discord, past depression, and metabolic responses to high-fat meals: Interpersonal pathways to obesity

BACKGROUND Longitudinal studies have implicated both marital distress and depression in the development of the metabolic syndrome, a risk factor for diabetes and cardiovascular disease. This study addressed the impact of hostile marital interactions and a mood disorder history on obesity-related metabolic responses to high-fat meals. METHODS This double-blind, randomized crossover study included serial assessments of resting energy expenditure (REE), fat and carbohydrate oxidation, triglycerides, insulin, glucose, interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-α) before and after two high-fat meals. During two separate 9.5h visits, 43 healthy married couples, ages 24-61 (mean=38.22), received either a high saturated fat meal or a high oleic sunflower oil meal, both 930kcal and 60g fat. The Structured Diagnostic Interview for DSM-IV assessed mood disorder history. Couples discussed a marital disagreement during both visits; behavioral coding of these interactions provided data on hostile marital behaviors. RESULTS Men and women who displayed more hostile behaviors and who also had a mood disorder history had significantly lower post-meal REE, higher insulin, and higher peak triglyceride responses than other participants, with nonsignificant effects for fat and carbohydrate oxidation. Participants with a mood disorder history had a steeper rise in postprandial IL-6 and glucose than those without a past history. Higher levels of hostile behaviors were associated with higher post-meal TNF-α. The two meals did not differ on any outcome assessed. CONCLUSIONS People spend about 18 of every 24h in a postprandial state, and dining with ones partner is a common daily event. Among subjects with a mood disorder history, the cumulative 6.75-h difference between high and low hostile behaviors translates into 128kcal, a difference that could add 7.6pounds/year. Our findings illustrate novel pathways through which chronic marital stress and a mood disorder history synergistically heighten the risk for obesity, metabolic syndrome, and cardiovascular disease.

Depression, daily stressors and inflammatory responses to high-fat meals: when stress overrides healthier food choices

Depression, stress and diet can all alter inflammation. This double-blind, randomized crossover study addressed the impact of daily stressors and a history of major depressive disorder (MDD) on inflammatory responses to high-fat meals. During two separate 9.5 h admissions, 58 healthy women (38 breast cancer survivors and 20 demographically similar controls), mean age 53.1 years, received either a high saturated fat meal or a high oleic sunflower oil meal. The Daily Inventory of Stressful Events assessed prior day stressors and the Structured Clinical Interview for DSM-IV evaluated MDD. As expected, for a woman with no prior day stressors, C-reactive protein (CRP), serum amyloid A (SAA), intercellular adhesion molecule-1 (sICAM-1) and vascular cell adhesion molecule-1 (sVCAM-1) were higher following the saturated fat meal than the high oleic sunflower oil meal after controlling for pre-meal measures, age, trunk fat and physical activity. But if a woman had prior day stressors, these meal-related differences disappeared—because the stressors heightened CRP, SAA, sICAM-1 and sVCAM-1 responses to the sunflower oil meal, making it look more like the responses to the saturated fat meal. In addition, women with an MDD history had higher post-meal blood pressure responses than those without a similar history. These data show how recent stressors and an MDD history can reverberate through metabolic alterations, promoting inflammatory and atherogenic responses.

Weight and body fat changes in postpartum depot-medroxyprogesterone acetate users

BACKGROUND Although postpartum depot-medroxyprogesterone acetate (DMPA) recipients often cite weight gain as the reason for discontinuing DMPA, little is known about body composition changes in postpartum DMPA recipients. STUDY DESIGN Women who used DMPA during the postpartum year were measured on several anthropometric dimensions of body composition and compared with women who elected surgical sterilization with bilateral partial salpingectomy (BPS). RESULTS After 1 year, DMPA recipients did not differ from the BPS group in weight or percent body fat changes. Almost half the women using DMPA returned to pregravid weight; nearly half gained weight. Higher pre-pregnancy body mass index was associated with weight gain among DMPA recipients. CONCLUSIONS DMPA recipients who were overweight or obese before pregnancy may have greater risk for weight gain in the first year postpartum. However, when counseling women, the risk for DMPA-related weight gain should be balanced against the potential for increased weight from subsequent pregnancies.

Nutritional and Safety Outcomes from an Open-Label Micronutrient Intervention for Pediatric Bipolar Spectrum Disorders

OBJECTIVE The purpose of this study was to report the safety, tolerability, and serum micronutrient concentrations and their correlations with mood changes from an 8 week pilot feasibility study of a 36 ingredient multinutrient supplement, EMPowerplus (EMP+), for pediatric bipolar spectrum disorders (BPSD). METHODS Ten children ages 6-12 received EMP+ escalating from one to four capsules t.i.d., with four children increased to the maximum suggested dose, five capsules t.i.d. Outcome measures were micronutrient concentrations in serum and red blood cells, vital signs, body mass index (BMI), dietary intake (Food Frequency Questionnaire and 24 hour dietary recall interview), and mood and global functioning ratings. RESULTS Seven children (70%) completed the study. Three (30%) terminated early for tolerability and compliance issues. Adverse effects were mild and transient, and chiefly consisted of initial insomnia or gastrointestinal (GI) upset. No differences occurred in BMI (p = 0.310) or waist-hip ratio (WHR; p = 0.674) pre- to postsupplementation. Four of the tested serum vitamin concentrations increased from pre- to postsupplementation: vitamin A-retinol, vitamin B6, vitamin E-α-tocopherol; and folate (all p<0.05). The increase in serum 25-OH vitamin D approached significance (p = 0.063). No differences were found in dietary intake pre- to postsupplementation, suggesting that blood nutrient level increases were caused by EMP+. CONCLUSIONS In this open prospective study, short-term use of EMP+ in children with BPSD appeared safe and well-tolerated, with a side effect profile preferable to first-line psychotropic drugs for pediatric bipolar spectrum disorders. A double-blind, randomized clinical trial is feasible, appears safe, and is warranted by open-label clinical outcomes and plausible mechanisms of action, combined with documentation of increased serum concentrations of specific micronutrients.

Novel Links Between Troubled Marriages and Appetite Regulation Marital Distress, Ghrelin, and Diet Quality

Distressed marriages enhance risk for health problems; appetite dysregulation is one potential mechanistic pathway. Research suggests that ghrelin and leptin, appetite-relevant hormones connected to shorter and longer-term energy balance, may differentially affect people with a higher versus lower body mass index (BMI). During this double-blind randomized crossover study, both members of a couple (N = 86 participants) ate a standardized meal at the beginning of two visits. Observational recordings of a marital conflict assessed marital distress. Ghrelin and leptin were sampled premeal and postmeal at 2, 4, and 7 hr. Diet quality was measured using the USDA 24-Hour Multiple-Pass Approach. People in more distressed marriages had higher postmeal ghrelin (but not leptin) and a poorer quality diet than those in less distressed marriages, but only among participants with a lower BMI. These effects were consistent for both spouses. Ghrelin and diet quality may link marital distress to its corresponding negative health effects.

Low sodium diet: nutritional adequacy and factors limiting adherence

Background: Existing data suggest that nonadherence to low-sodium diet (LSD) is the most common cause of rehospitalization among heart failure (HF) patients. Yet, little is known about specific factors that affect patients’ ability to follow this commonlyprescribed measure. Further, many have expressed concern that patients who follow a LSD may suffer nutritional deficits that could counterbalance any positive effects of the LSD. Method and Results: The specific aims of this prospective, comparative study were to: a) describe factors that influence the ability of participants to follow a LSD, b) determine the relationship between self-reported adherence to prescribed LSD and actual sodium intake, and c) determine the nutritional adequacy of a LSD. Patients recruited from two Midwestern HF clinics filled out a questionnaire that measured perceptions about ability to follow a LSD and identified factors that limit ability to follow the diet. Thirty days later, they filled out a 4-day food diary and completed a 24-hour urine collection to measure urine sodium. Twelve males and 11 females with a mean age of 65 yrs and NYHA functional class II or III participated in the study. Sodium intake was 3.2 g for those who reported always following a LSD, 2.6 g for those who followed it most of the time, and 4.1 g. for those who never followed it. Thirty-three percent said it was difficult to follow the LSD, while 66% reported it was easy. Sodium intake on 4-day food diary and 24-hour urine sodium were strongly correlated (r 0.55, p 0.05). The factors reported most to hinder ability to follow the LSD were: friends/relatives don’t serve low sodium foods; difficult to find appetizing low sodium food, to keep track of total daily sodium intake, and to identify low sodium foods in restaurants. No relationship between perceived difficulty following the LSD and actual sodium intake was found. Individual daily caloric intake ranged from a low of 318 kcal to a high of 3,373 kcal, with a four-day group average intake of 1,548 ( 361) kcal. The percent of calories from fat ranged from 21 percent to 50 percent, with a mean of 34 ( 7) percent. The percent of calories derived from carbohydrate sources ranged from 23 percent to 61 percent, with a mean of 50 ( 10) percent. The percent of calories from protein sources ranged from 9 to 27 percent with a mean of 17 ( 4) percent. The only macronutrient related to sodium intake was protein (r 0.58, p 0.05). Protein intake of patients with high sodium intake ( 3g) was significantly greater than those with low sodium intake. All diets were deficient in at least one nutrient, regardless of sodium intake. Themost common nutrient deficiency was magnesium (76%), followed by vitamin A (74%), calcium (71%), and vitamin D (65%). Conclusions: Some patients were able to limit sodium intake, however actual sodium intake was not related to perceived ability to follow a LSD nor selfreported adherence. Further, many individuals with HF may have multiple nutritional inadequacies regardless of their level of sodium intake, although protein deficiencies are prominent in those most closely following a LSD. Modulating the Cost of Prolonged Survival in Heart Failure: Long-Term Benefits of a Nurse-Led, Multidisciplinary, Home-Based Intervention Simon Stewart1—School of Nursing & Midwfery, University of South Australia, Adelaide, South Austrlia, Australia

1460 Dietary Fat Intake Affects Proinflammatory Cytokine Levels and Event-Free Survival in Patients with Heart Failure

analyser (Reflotron, Roche Diagnostics) to measure potassium and creatinine. This was in a big suitcase and including a laptop and a blood pressure apparatus we needed to use a carrier-bike when visiting the patients. The task for the nurse was education of the patient, check of compliance, up-titration of medication and control of laboratory parameters. Results: 10 patients was included between April and September 2004. For the moment we are making a status for death, admissions, ordinary visits and phone consultations, QoL-schemes and quality-cheque of the blood samples. Conclusions: The patients have subjectively been very happy. For the nurse it have been exciting, educational, motivating and committing. Further analysis will be presented. Future: We are aiming for a mutual project with the four participating hospitals in Copenhagen.